Development of CountrySpecific Plans for TB Drug Selection and Use

1
Development of Country-Specific Plans for TB Drug
Selection and Use Benin, Congo Brazzaville, DRC,
Nigeria, and Uganda
2
Selection

• Problem Area
• 4 FDC registration needed
• FDCs not on on EDL
• STGs need to be updated

• Selected Activity
• Register drugs (Uganda, Nigeria, CB)
• Add to EDL (Nigeria, Uganda, DRC)
• Committee in place, currently in process
  (Nigeria).
• (CB, DRC)

3
Selection, continued

• Problem Area
• Blister pack configuration and implementation
• Poor distribution of drugs to sub-county health
  workers

• Selected Activity
• Selection committee needed NTP manager, NDA,
  clinical specialist (TB physician, nurse,
  pharmacist) (Uganda)
• Bicycles and small motorcycles needed to access
  remote areas

4
Use

• Problem Area
• Default rate too high related to adherence to
  drug treatment

• Selected Activity
• Open more centers closer to patients (Nigeria,
  CB)
• Health workers training, education campaigns
  (CB)
• Research to understand the problem (Benin)

5
Use, continued

• Selected Activity
• Train health personnel (CB, Nigeria)
• Train medical students (Nigeria)
• Introduce new STGs to prescribers and monitor
  their use (DRC)

• Problem Area
• Prescribers not following STGs

6
Use, continued

• Selected Activity
• Train prescriber in rational drug use, have
  patient go to public sector for drugs (meeting,
  training, registration) (DRC)

• Problem Area
• Poor use in private sector
• Community capacity strengthening and team
  building needed

7
Procurement Quantification

• Problem Area
• NTP not involved in quantification
• Staff poorly trained in quantification
• Different groups ordering TB drugs

• Selected Activity
• Meet w/ DM committee (DRC)
• Train existing NTP staff at all levels (Nigeria,
  CB)
• Hold quantification meeting with all key
  government agencies (Nigeria, Uganda)

8
Quantification, continued

• Problem Area
• Forms needed for participation
• Slow importation process
• Value of data uncertain

• Selected Activity
• Sensitizing and training TB personnel (Benin)
• Meeting with all branches of the government
  (Nigeria)
• Conduct study to compare consumption and
  morbidity data (Uganda, DRC)

9
Procurement

• Problem Area
• No government funds for Procurement
• No line item in budget for TB drugs
• NTP lacks experience in TB drug procurement

• Selected Activity
• Advocacy at the highest level (MOH, President)
• (DRC, Nigeria, Benin)
• Establish pooled mechanisms (Uganda)
• Advocacy (CB, Benin)
• Secure funds and technical assistance to train
  staff (CB)
• Funds and technical assistance needed (CB)

10
Distribution

• Problem Area
• Poor storage in drug warehouses
• Lack of storage space
• Poor distribution of drugs to peripheral areas
• No distribution system with community DOTS

• Selected Activity
• Upgrade facilities
• (e.g., add air conditioning)
• (Benin, CB, DRC)
• Currently building a new storage facility (DRC)
• Using advocacy, secure funds from the MOH to
  deliver drugs by air/train (CB, DRC, Benin,
  Nigeria)
• Secure bicycles and motorcycles (Uganda)

11
Distribution, continued

• Problem Area
• No information on drugs in periphery
• No information on storage facilities

• Selected Activity
• Drug information management system (Uganda, DRC)
• Assessment (Nigeria)

12
Management Support

• Problem Area
• Data from management systems not being used

• Selected Activity
• System rationalization and training